Provider Demographics
NPI:1285943100
Name:LONG, ROSEMARY E (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ROSEMARY
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ROSEMARY
Other - Middle Name:E
Other - Last Name:LEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4940 EASTERN AVENUE
Mailing Address - Street 2:JOHNS HOPKINS BAYVIEW
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-550-7852
Mailing Address - Fax:
Practice Address - Street 1:4940 EASTERN AVENUE
Practice Address - Street 2:JOHNS HOPKINS BAYVIEW
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-550-7852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-27
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC04333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant